Medicaid changes imperil drug-addiction treatment

The Republican proposal to replace the Affordable Care Act would strip away what advocates say is essential coverage for drug-addiction treatment as the number of people dying from opiate overdoses is skyrocketing nationwide.

Beginning in 2020, the plan would eliminate an Affordable Care Act requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans.

The proposal also would roll back the Medicaid expansion under the act, which would affect many states bearing the brunt of the opiate crisis, including Ohio, Kentucky and West Virginia.

“Taken as a whole, it is a major retreat from the effort to save lives in the opiate epidemic,” said Joshua Sharfstein, associate dean at Johns Hopkins Medical School.

Advocates and others stress that mentalhealth disorders sometimes fuel drug addiction, making both benefits essential to combating the opioid crisis.

Nearly 1.3 million people receive treatment for mental-health and substance-abuse disorders under the Medicaid expansion, according to an estimate by health-care economists Richard Frank of the Harvard Medical School and Sherry Glied of New York University.

House Republicans on the House Energy and Commerce Committee argue that the changes would give states additional flexibility in coverage decisions and believe they would continue to provide addiction and mental-health coverage to Medicaid recipients if needed.

But several Republican senators expressed concern. Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska sent a letter to Senate Majority Leader Mitch McConnell, R-Ky., stating that the plan does not “provide stability and certainty” for individuals and families enrolled in Medicaid expansion programs or flexibility for states.

President Donald Trump has made combating the nation’s drug-overdose problem a focal point of his campaign and his presidency.

“We will stop the drugs from pouring into our country and poisoning our youth,” he said in a speech before Congress last week, “and we will expand treatment for those who have become so badly addicted.”

Trump has endorsed the Republican plan to replace the ACA.